The ACA and Narrow Networks for Mental Health

By Gilbert Benavidez, PHP Fellow

October 12, 2017

Databyte

Even if you have insurance you may not be able to see the doctor you like because they are not covered by your insurance plan, or are ‘out-of-network.’ In a recent Health Affairs article, Zhu, et al. explored this issue of network adequacy in mental health care compared to primary care.

The authors examined data from 531 unique provider networks in the ACA marketplaces. They found that compared to primary care providers, the percentages of both physician and non-physician mental health care providers were much lower. Mental health care physicians were out of network almost 60% of the time, while primary care physicians were only out of network around 40% of the time. The authors acknowledge the importance of the issue: “There is increasing concern about the extent to which narrow-network plans…affect consumers’ choice of and access to specialty providers…” The discrepancy is even more apparent in the graph below:

The authors write that “These findings raise important questions about provider-side barriers to meeting the goal of mental health parity regulations: that insurers cover mental health services on a par with general medical and surgical services. Concerted efforts to increase network participation by mental health care providers, along with greater regulatory attention to network size and composition, could improve consumer choice and complement efforts to achieve mental health parity.”

Gilbert Benavidez received his MPH at the Boston University School of Public Health, where his concentration was health law, bioethics and human rights. He is primarily interested in international human rights law and policy and the associated interactions with socio-political developments. He also loves pizza and sushi.